Quality Pay under the New Medicare Bill

Value-based payment is definitely a hot topic. CMS and the Medicare program plan to lead the way. Physician payment linked to quality measures has already been introduced via PQRS.

Although the intent is clear, the pathway is still philosophical and unproven. In the article below,  John Tozzi from Bloomberg News reports on the confusion about establishing exactly which measures will be selected for inclusion in future payment protocols.

The Problem With Obama’s Plan to Pay Doctors Based on Performance

As Medicare prepares to begin rating doctors on a scale from 0 to 100, there’s confusion about how to define success.

By John Tozzi | May 8, 2015

Until recently, the U.S. government and insurance companies paid doctors for volume of services provided, rewarding them for needless treatments. Economists and policymakers have long called for flipping those incentives so physicians are paid for the quality, not quantity, of care they deliver. That goal is embedded in the Affordable Care Act, which penalizes hospitals when patients get readmitted. Paying for quality is an approach that private insurers, employers, and state Medicaid plans have adopted.

In April, President Obama signed a bipartisan Medicare reform bill that mandates linking doctor pay to performance. Under the new law, Medicare, which insures 54 million elderly and disabled Americans, will begin rating doctors on a scale from 0 to 100 based on factors such as quality and efficiency. Top-scoring physicians will eventually be paid at rates above standard Medicare fees, and laggards will face penalties.

Click here to read more…

Original Post By: Bloomberg Politics

Giant Steps Made in SD Health Record Exchange

Scripps Mercy Physician Partners and the Physician Resource Center have actively supported the sharing of patient information to increase the quality and cost-effectiveness of health care.

We are pleased with the giant steps that are being made in the sharing of patient information by San Diego Health Connect and the San Diego health systems as reported in the May 11, 2015 issue of the San Diego Union-Tribune!

Million SD Patient Records Become Shareable

By Paul Sisson | May 11, 2015

More than 1 million patients with Sharp HealthCare, Scripps Health and UC San Diego will soon automatically participate in San Diego’s medical record-sharing network unless they decide to opt out.

The three health systems are transmitting digital consent forms for all of their recent patients to San Diego Health Connect, a nonprofit information exchange that helps doctors quickly and securely view medical information even if it resides across town at a different organization.

Click here to read more…

Original Post By: U-T San Diego

ICD-10 Preparation, Time to Purchase IMO, PQRS, MU Deadlines

ICD-10: Deadline October 1, 2015

While many people have discussed the possibility of the ICD-10 implementation date changing, at this point, the deadline remains October 1.

In order to prepare for this important change, we recommend the following steps be taken.

1.  Watch a Physicians Trust Recorded webinar on the Physicians Trust website under education and training/training/ICD-10
2.  Review the ICD-10 resource guide created by Physicians Trust
3.  Review ICD-10 related documentation on the https://my.eclinicalworks.com website (username and password are required for access)
4.  Sign up for CMS updates on ICD-10 here http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html
5.  Consider IMO smart search as a tool to enhance your ICD-10 conversion. Details can be found here https://www1.e-imo.com/ecw/
6.  If you want to test prior to the October 1st, 2015 deadline you will need to open a support ticket by sending an email to [email protected]
7.  Consulting services from Physicians Trust can be purchased at www.hit-shop.net or by contacting [email protected]

Several of the tasks required to successfully transition to ICD-10 must be performed by your internal staff and providers. Physicians Trust trainers can be scheduled to guide you on best practices, however your time and commitment is critical to successfully transitioning to ICD-10. Physicians Trust training and support teams are not certified coders.

Obama Signs Bill Fixing Medicare Doctors’ Pay

Read more here: http://www.reuters.com/article/2015/04/16/us-usa-congress-medicare-obama-idUSKBN0N72QM20150416

IMO Gives You Easy to Find, Clinically Meaningful Diagnoses and Billable Codes

IMO provides clinicians with the ability to quickly and accurately create a patient’s problem list within the eClinicalWorks EMR system using common clinical terms. You will experience improved usability of your EMR, less need to input free text, and more accurate coding resulting in fewer after-encounter conversations and back-tracking. The end result is a more satisfied physician.
We recommend that you consider IMO before transitioning to ICD-10. Click here for an FAQ and click here for details on how to purchase from eCW.

Physician Quality Reporting System (PQRS)

eClinicalWorks continues to support claims-based reporting in 2015 for individual reporting only

In 2015, claims-based reporting is only available for eligible providers (EPs) using the Individual Reporting method. CMS notes that other clinical-based reporting options have reported greater success for EPs. In 2015, to avoid the PQRS penality, an EP has to report at least nine Quality Measures, across three NQS domains, and have at least one cross-cutting measure.

For more information please see the eClinicalWorks PQRS update atttached here.

MEANINGFUL USE REMINDERS:

Don’t forget to check your MAQ Dashboard each month after the 12th to make sure you are in compliance with the correct measures.

The deadline for applying for both MediCaid MU and AIU in 2014 has been extended to May 31, 2015 because of the delay in the ability of the SLR to accept 2014 applications under the Flexibility Rule. Please see the link below for more details. http://medi-cal.ehr.ca.gov/

Please check your state level registry frequently to confirm deadlines. You can find it at http://www.cms.gov/apps/files/statecontacts.pdf

eClinicalWorks National User’s Conference
October 16-19, 2015
Nashville, TN
Early registration is now available for eCW National User’s Conference. Book now for the best rates and hotel rooms.
Register Here

SGR Update, from SDCMS & CMA

Important update on SGR that was provided by San Diego County Medical Society and the CMA –

We applaud the excellent advocacy provided by SDCMS and CMA and urge you to contact your legislators!

Yesterday, the House and Senate reintroduced the bipartisan SGR bill that marries the SGR payment reform policy with the funding sources.  It also extends the Children’s Health Insurance Program (CHIP) for two years at the higher ACA funding levels.  The bill is H.R. 2 “The Medicare And CHIP Reauthorization Act” (MACRA).  Below is a summary of the major provisions:

• SGR Payment Policy Remains the Same: Repeals the SGR; Provides automatic 0.5% updates each year for 4 years; In 2019 physicians can choose from two payment tracks: 1: Fee-For-Service Track that simplifies and consolidates the quality reporting programs and reinstate large bonuses up to 12% and reduces current penalties; 2: Alternative Payment Model Track that provides 5% bonus payments.  The new payment models and the quality measures are to be developed by physicians.  There is also $125 million in funding assistance for small practice physicians.
• Extends the expiring CHIP Program for 2 years at the higher ACA funding levels.  It covers nearly 1 million kids in California who would lose their insurance without it. (The Senate Democrats want 4 years and are trying to decide whether to hold up the bill to get 4 years.  The Children’s Groups are supporting the House 2 year version to get the bill passed out of the House but are pushing the Senate to try for 4 years.  The Senate Republicans are resisting because they have already agreed to continue CHIP at the higher ACA funding levels.)
• Extends the expiring Community Health Center funding. (Hyde amendment language that bans federal funding of abortions has been tied to the Community Health Center appropriations since 1979.  However, the original House language codified the Hyde amendment going forward which drew opposition from the reproductive rights groups.   There is new compromise language that seems to have resolved the issue.  However, it has kept many House and Senate Democrats from supporting the bill thus far.)
• Extends the important National Health Service Corps and the Teaching Health Center Rural primary care residency programs through 2017.  There are 4 programs in CA.
• Reverses the CMS decision to eliminate the bundled payments for 10-day and 90-day global surgical service. Also requires CMS to collect data on these services.
• Makes permanent the Qualifying Individual Medicare program that helps low-income seniors pay for premiums and continues the Transitional Medical Assistance Program for Medicaid.
• Extends the moratorium on RAC audits of the hospital two-midnight rule which helps hospitals and physicians.
• Delays the ACA cuts to DSH hospitals for one more year.

FUNDING SOURCES:

1. The $200+ billion bill will not be fully offset with funding sources.  The SGR repeal piece will not be offset. 
   • For 12 years, Congress has stopped the SGR payment cuts so the SGR never takes effect.  Therefore, the SGR savings to the federal govt are phony.  Speaker Boehner and Leader Pelosi have rightly concluded that Congress does not need to “pay for” a phony cost.  The Wall Street Journal and the Americans For Tax Reform (Grover Norquist) agree.  However, this provision is being opposed by the Heritage Action Network and they are asking Republicans to oppose the bill because it is not fully paid for.
2. The remaining $70 billion will come from the following:
   • New deductibles for MediGap policies starting in 2020.
   • Increased premiums for the 2% of very high income Medicare beneficiaries: 15% more for couples making $267-320,000 and 20% more for couples making more than $320,000 in retirement income.
   • ~$35 billion in payment cuts to hospitals and others providing post-acute care services.   This does not apply to physicians.

OPPOSITION:

• Because of the opposition from conservative groups around the funding offsets, we need physicians to continue to work the Republican Members and tell them this bill is fiscally responsible.
• Because of the confusion related to the abortion language and the controversy over extending CHIP for 2 years vs. 4 years and some light pressure from AARP, most of the California  Democrats have yet to commit to vote for the bill.  Most Members of the California delegation are leaning yes but we need to push them securely into the YES column. We need a big vote in the House.

CMA Call to Action for CMA & County Medical Society Physician Leaders

Passage of Medicare SGR reform could be a reality: Call your Members of Congress today – before the March 24 House Floor Vote!

Congress is on a fast track to beat an April 1 deadline to pass a bipartisan plan to repeal and replace the flawed Medicare sustainable growth rate (SGR). U.S. House Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) have negotiated a bipartisan agreement to fund the Medicare SGR payment reform legislation and they intend to hold a vote on the House floor as early as Tuesday March, 24.  House Majority Leader, Kevin McCarthy (R-CA), said that “Congress has never been closer.”  The Senate is expected to follow with a floor vote.

Last year, identical legislation was unanimously approved by the three House and Senate committees with the support of more than 750 state and national physician organizations, but failed to pass Congress because leadership in both houses could not agree on funding sources for the law. Physicians wound up with the 17th short-term SGR patch in a decade.

In addition to eliminating the flawed SGR payment formula, the bill includes the choice of two payment tracks for physicians. Track 1 is a fee-for-service program that consolidates the quality reporting programs, reinstates large bonuses (up to 12 percent) and reduces the penalties for quality programs.  Track 2 is  the Alternative Payment Model Track.  It provides 5 percent bonus payments and includes new care models like medical homes. The new payment models and quality measures are slated to be developed by physicians. The bill also includes $125 million in funding assistance to help small practices transition. Until these payment tracks are in place, physicians will receive a 0.5 percent update annually for three years.

After years of kicking the can down the road, both Boehner and Pelosi have agreed that the $120 billion phony cost to repeal the SGR does not now need to be fully “paid for.”

The bill also includes new Medicare spending (approximately $70 billion) for physician payment increases, bonuses and extenders that will be offset with corresponding funding. The funding sources include payment cuts to hospitals and others for post-acute care and premium increases for very high-income seniors for Medicare Part B and Medicare Part D (pharmacy benefits) as well as a deductible for new Medigap policies.

Some conservative groups are asking for a “NO” vote because they claim the bill will increase the deficit.  However, the Wall Street Journal, the Americans for Tax Reform and many other conservatives are joining Speaker Boehner to urge its passage.  They argue that it is fiscally responsible to repeal the SGR and enact the structural beneficiary reforms that will put Medicare on a path to solvency. The AARP has expressed concerns with the increased premiums although they will impact very few high-income seniors.  Despite these concerns, Leader Pelosi is urging her Democratic caucus to support the bill because it finally stabilizes physician payments and extends the Children’s Health Insurance Program.

That is why your support at this final hour is key. With bipartisan support from Congressional leadership for both the policy and the funding, we have never been this close. However, thousands of physicians and patients must call and email their federal Representatives and Senators as soon as possible to overcome the opposition and ensure the bill’s final passage.

Call your Representatives now! Put the SGR over the finish line!

To make a call from the American Medical Association Grassroots Hotline, dial 800 833 6354 and enter your ZIP code to be automatically connected to your representative. Give your name, specialty and practice location, and don’t forget to call back to connect to our California Senators.  Be sure to tell them you are a physician leader in the CALIFORNIA MEDICAL ASSOCIATION AND THE COUNTY MEDICAL SOCIETY.

Click here to download a sample script you could use in a phone call or message.

Urge your Representative and Senators to:

Vote YES on the Medicare SGR physician payment legislation.

The bill is fiscally responsible and does not increase the deficit.

This bill will stabilize my practice and protect access to care for my patients – seniors, the disabled and military families in our community.

IT’S TIME TO FIX MEDICARE NOW!

Contact: Elizabeth McNeil, (800) 786-4262 or [email protected].